tbuckley/cabot-search huggingface dataset:
Abstract 226: Long-term Trajectory Of Neurologic Outcome After Severe Traumatic Brain Injury
Authors: Henry Wang, Chengcheng Hu, Bruce J Barnhart, Jan Jansen, Daniel W Spaite
Journal: Circulation (2022)

Objective : Little is known about the time-based trajectories of neurologic recovery after traumatic brain injury (TBI). We sought to determine long-term changes in neurologic status after TBI. Methods: Data source: Resuscitation Outcomes Consortium Hypertonic Saline TBI Trial. Included: adult TBI, GCS≤8; Excluded: shock (SBP≤70, or SBP 71-90 with HR≥108). Primary outcome: Glasgow Outcome Scale-Extended (GOS-E; 1=dead, 8=no disability) determined at: a) hospital discharge and b) 6-months. We analyzed changes in GOS-E between hospital discharge and 6-months using Sankey graphs and the Wilcoxon signed-rank test. We repeated the analysis for the high acuity subset of patients undergoing EMS advanced airway insertion. Results: Among 1,282 TBI, GOS-E at discharge was: dead (GOS-E 1) n=321 (25.0%), unfavorable (2-4) n=664 (51.8%), favorable (5-8) n=220 (17.2%), missing n=77 (6.0%; Figure). GOS-E at 6-months was: dead n=346 (27.0%), unfavorable n=282 (22.0%), favorable n=459 (35.8%), missing n=195 (15.2%). While 7 of 220 (3.2%) with favorable GOS-E at discharge worsened at 6 months (unfavorable or died), 300 of 664 (45.2%) with unfavorable GOS-E improved to favorable at 6 months (Wilcoxon signed-rank for GOS-E change p&lt;0.0001). In the EMS advanced airway subset (n=774), 2 of 96 (7.1%) with favorable GOS-E at discharge worsened to unfavorable (or were dead) at 6 months, while 208 of 433 (48.0%) with unfavorable GOS-E improved to favorable at 6 months (Wilcoxon signed-rank for GOS-E change p&lt;0.0001). Conclusion: Among patients with TBI and unfavorable neurologic status at hospital discharge, almost half will progress to favorable neurologic status at 6 months. Very few TBI victims die or worsen to unfavorable neurologic status by the time of 6-month follow-up. Thus, assessment of long-term neurologic outcome should be considered for studies of TBI.
Abstract 15841: Echocardiographic Parameters Are Correlated With Initial Infection Severity in Long-Term Post Covid-19 Patients
Authors: Mladen Grigorov, Jiapeng Huang, Shahab Ghafghazi, Forest Arnold, T'shura Ali, Qian Xu, Maiying Kong, Rodrigo Cavallazzi, James Chen
Journal: Circulation (2022)

Introduction: COVID-19 acutely affects the cardiovascular system leading to various cardiac complications. Major concerns are on the less understood long-term cardiovascular consequences of COVID-19. Hypothesis: Post COVID-19 cardiac dysfunctions could be long lasting and vary by severity of initial infection. Methods: This is an on-going prospective observational study from a multidisciplinary Post COVID-19 Research Clinic. Inclusion criteria included both RT-PCR confirmed and recovered COVID-19 patients and control subjects. After IRB approval and informed consents, 83 participants received serial transthoracic echocardiography at 3, 6 or &gt;12 months after initial infection. Pearson’s correlation coefficients, Fisher's exact test and one-way ANOVA was conducted to examine the association between variables, across follow-up time and severity of initial infection. Results: Proximal RVOT diastolic diameter was significantly larger at &gt;12 months’ compared to earlier time points post COVID-19 (2.92±0.55 cm at 3 months, 2.81±0.57 cm at 6 months and 3.15±0.52 cm at &gt;12 months). The posterior wall was significantly thicker in post COVID-19 patients with moderate or severe infection compared to patients with mild infection. The left atrium diameter was significantly larger as the initial infection severity increased. Pulmonary artery acceleration time was significantly shorter as initial infection severity increased indicating higher pulmonary arterial pressure although no significant relationship was found with follow-up time. There were no left ventricular ejection fraction, E/E’ (index of diastolic function) or valvular abnormality differences by either follow-up time or severity. Furthermore, 77% patients with severe infection had grade 1 diastolic dysfunction compared to mild (28.57%) or moderate (33.33%) patients. Conclusions: Long-term echocardiographic follow-up showed increased RV size after COVID-19 over time. Posterior wall thickness, left atrium size and pulmonary artery acceleration time, and diastolic dysfunction were correlated with initial infection severity in long-term post COVID-19 patients suggestive of possible structural changes in recovered patients from COVID-19.
Abstract 15623: Arrhythmia Burden and Associated Outcomes Among Patients With Myelodysplastic Syndromes
Authors: Olamide Oyenubi, Omolegho Momoh, Priscila Hirst, Patrick Benjamin, Daniel Pomerantz, Marvyn Allen G Chan, Stephen Jesmajian
Journal: Circulation (2022)

Background: Arrhythmias are an increasingly recognized comorbid condition among patients with cancers. However, there is little research on the relationship between conduction abnormalities and in-hospital outcomes in patients with myelodysplastic syndrome (MDS). This analysis explores the burden of cardiac arrhythmias and associated outcomes in hospitalized MDS patients. Methods: Nationwide Inpatient Sample from 2017 to 2019 was used. MDS-associated hospitalizations with concurrent arrhythmia were identified using appropriate ICD-10 CM codes and compared to MDS-associated hospitalizations without arrhythmia. Primary outcome was all-cause in-hospital mortality. Secondary outcomes were in-hospital length of stay and total costs. Results: About 21% (n=4065) of MDS patients were diagnosed with an arrhythmia. Atrial tachycardias were most common (87%). Frequency of bradyarrhythmias, ventricular tachycardias, and unspecified arrhythmias were 10.7%, 10.4%, and 0.8%, respectively. The MDS-arrhythmia cohort were significantly older (78 vs 71 years), had higher number of comorbidities (&gt;3 Charlson Comorbidity Index score: 45.5% vs 30%), and were more likely men (57.8% vs 52.7%) (P &lt; 0.001). The MDS-arrhythmia cohort demonstrated higher all-cause mortality (10.6% vs. 5%) and had increased odds of in-hospital death after adjusting for sociodemographic and hospital level factors (AOR 2.2, 95% CI 1.59-2.91) (P &lt; .001). Hospital length of stay (8.5 vs. 8.0 days) and hospital charges ($104267 vs. $105654) were similar across both groups. Conclusions: Concurrent arrhythmias were associated with worse survival outcomes for patients with MDS. Understanding the mortality associated with arrhythmias in MDS patients may have clinical implications when planning treatment options in which cardiotoxicity is an adverse event. Awareness of the frequency and risk factors for arrhythmias in MDS patients may encourage the early introduction of cardiac monitoring for arrhythmias in hospitalized patients with MDS.
Abstract 15539: Echocardiographic Predictors of Early Myocardial Dysfunction in Duchenne Muscular Dystrophy
Authors: Jessica Sanchez, Beth Kaufman, Shiraz A Maskatia, Rajesh Punn
Journal: Circulation (2022)

Introduction: Cardiomyopathy, a well described complication of Duchenne Muscular Dystrophy (DMD), typically presents in adolescence or early adulthood. Transthoracic echocardiography (TTE) is a widely utilized and cost-effective tool to diagnose and monitor its progression. To our knowledge, there is no standardized, echocardiography-based risk stratification to predict progression to DMD cardiomyopathy. We aim to identify markers associated with eventual left ventricular (LV) dysfunction in patients with DMD cardiomyopathy, while they still demonstrate preserved normal LV ejection fraction (LVEF). Methods: We reviewed TTEs of patients with DMD from a single institution and identified their first instance of reduced LVEF (&lt;55%), as well as two preceding TTEs occurring 6-24 months prior. At each time point, we assessed LVEF, LV diastolic parameters, LV global longitudinal strain (LVGLS), LV and atrial volumes. We compared these parameters to 26 age-matched control DMD patients without evidence of LV dysfunction. Results: We identified 28 pediatric DMD patients with LVEF &lt;55%. At each time point preceding reduced LVEF, the average LVGLS and average LVEF were lower, compared to controls. Study patients also demonstrated increased LV end systolic volume, and diminished LVEF and LVGLS over the course of the 3 time points (p&lt;0.05 for all). Logistical regression showed EF and LVGLS one year prior were independently associated with ventricular dysfunction (p = 0.029 and 0.028); age did not correspond with diminished EF. Conclusions: Patients with DMD demonstrate reduced LVGLS, as well as sequentially increasing LV systolic volume and decreasing LVEF prior to the onset of LVEF &lt;55%. These findings suggest a decline in myocardial mechanics &gt;1 year prior to a diagnosis of DMD cardiomyopathy. Recognizing changes in LV strain and volumes while patients are still in a compensated state of cardiac output, may lead to earlier detection of subclinical LV dysfunction.
Abstract 15569: Association of Volatile Organic Compound Levels With Pod-Based Electronic Cigarette-Induced Changes in Vascular Function of Young Adults
Authors: Sana A Majid, Jessica L Fetterman, Robert M Weisbrod, Andrew Stokes, Michael J Blaha, Sanjay Srivastava, Rose M Robertson, Aruni Bhatnagar, Rachel J Keith, Naomi M Hamburg
Journal: Circulation (2022)

Introduction: Pod-based electronic (e-) cigarettes including JUUL are the most frequently used product type in young adults. Here, we evaluated the acute and chronic impact of pod-based e-cigarettes on vascular health and their relation to volatile organic compound (VOC) exposure. Methods: We performed a short-term observational study of healthy young adults (N = 106) and recruited pod-based e-cigarette users (N = 48), combustible cigarette users (N = 21), and tobacco nonusers (N = 37). Vascular function via flow-mediated dilation and blood pressure (BP) was measured before and after 10-min structured product use of the participant's own product. Urinary VOCs were measured 1 hour after product use. In human aortic endothelial cells (HAECs) in culture exposed to select VOCs, nitric oxide production was measured with DAF-2 indicator. Results: Among pod-based e-cigarette users, 64% were exclusive users including 37% who had never used combustible cigarettes. Pod-based e-cigarette users and combustible cigarette users had higher systolic BP compared to non-users (121±11 mmHg, 121±13 mmHg, 112±10 mmHg, P=0.0004). Structured pod-based e-cigarette use acutely decreased flow-mediated dilation (-3.2±2.7%), raised systolic and diastolic BP (6±8mmHg, 4±5mmHg) and heart rate (5±7bpm), similar to combustible cigarette use (-2.6±2.6%, 9±8mmHg, 6±5mmHg, 6±6bpm P=0.83, 0.3, 0.4, 0.56 vs pod-based), and to a greater extent than nonuse (0.3±4.1%, 0.7±5mmHg, 0.3±3mmHg, -3±4bpm, P=1.0x10-7, 0.002, 0.003, 2.6x10 -7 ). Differences remained in models adjusted for age, sex, and race. The effect of pod-based e-cigarette use was similar in adults who had never used combustible cigarettes. Levels of VOCs acrolein, acrylamide, acrylonitrile, and crotonaldehyde were associated with changes in vascular health measures. Exposure of HAECs in culture to acrolein and acrylamide reduced acetylcholine-stimulated nitric oxide production. Conclusions: Our findings demonstrated that pod-based e-cigarette use had acute and chronic vascular effects in healthy young adults including those who never used combustible cigarettes. Select VOC metabolites were associated with the vascular changes and altered nitric oxide production suggesting relevance to vascular health.
Abstract 238: A Machine Learning Algorithm To Predict Refractory Ventricular Fibrillation
Authors: Jason Coult, Betty Y Yang, Heemun Kwok, Jennifer E Blackwood, Anjali Rajah, Nona Sotoodehnia, J. Nathan Kutz, Peter Kudenchuk, Thomas Rea
Journal: Circulation (2022)

Introduction: Guidelines for resuscitation of ventricular fibrillation (VF) out-of-hospital cardiac arrest (OHCA) advise drug therapy (epinephrine and antiarrhythmics) if a patient requires ≥3 shocks. Given that a higher number of shocks is associated with lower survival, the ability to predict which patients will require ≥3 shocks could enable preemptive, targeted intervention (antiarrhythmics or early hospital transport for invasive interventions) aimed at improving outcome. Aim: We sought to design an ECG-based algorithm to predict whether VF OHCA patients will require ≥3 shocks. Methods: We evaluated a cohort of adult VF OHCA from a metropolitan EMS system between 2008-2020. Patients were randomized 80%-20% for training-test. We trained an algorithm to predict whether a patient will require ≥3 shocks using 3-s ECG segments collected immediately before and within a minute after initial shock. The method uses a random forest classifier to predict shock count based on singular value decompositions of ECG wavelet transforms. Test performance was quantified by area under the receiver operating characteristic curve (AUC). Association between functional survival and shock count was evaluated with logistic regression. A sensitivity analysis assessed prediction of patients requiring ≥4 shocks. Results: Of 1376 VF OHCA patients, 311 (23%) were female; the median (IQR) shock count was 3 (1-6) and 591 (43%) achieved functional survival. Shock count was associated with lower functional survival with an odds ratio (95% CI) of 0.92 (0.89-0.95) for each additional shock. In 275 test patients, AUC (95% CI) was 0.80 (0.74-0.85) for predicting ≥3 shocks and 0.81 (0.75-0.85) for predicting ≥4 (Figure). Conclusions: A machine learning algorithm based on ECGs proximal to the initial shock predicts patients likely to experience refractory VF and high shock count, and could enable rescuers to preemptively administer interventions targeted to improve resuscitation outcome.
Abstract 15846: Etiologies for Hospitalizations and in Hospital Mortality in Patients With Heart Failure: Insight From National Inpatient Sample Database
Authors: Sean DeAngelo, Hasan Hammo, IRIAGBONSE ASEMOTA, Mahir Yilmaz, Muhammad Khawar Sana, Bharosa Sharma, Muhammad Usman, Muhammad Usman Almani, Hafeez Shaka
Journal: Circulation (2022)

Introduction: Heart failure is a common clinical syndrome that leads to high volumes of hospitalizations and in hospital mortality. Previous studies have attempted to characterize the various reasons for the high rates of morbidity and mortality associated with heart failure. Our study aimed to utilize large database information to identify the most common indicators for and cause of death in patients with heart failure. Methods: Using the National Inpatient Sample database, we analyzed heart failure hospitalizations during the years 2016-2019 and categorized reasons for hospitalization and in-patient mortality using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10). Results: We identified a total of 5,281,210 hospitalizations with heart failure as the principal or secondary diagnosis ICD-10 code. The leading cause for admission was heart failure (65%), followed by sepsis (8.5%), non ST elevation myocardial infarction (NSTEMI) (6.0%), acute chronic obstructive pulmonary disease (COPD) exacerbation (2.5%) and pneumonia (2.2%). There were a total of 161,417 cases of in-hospital mortality in patients with heart failure during this period. The most common reason for mortality was heart failure itself (49.8%), followed by sepsis (41.2%), NSTEMI (12.8%), acute hypoxic respiratory failure (7.8%) and acute-on-chronic hypoxic respiratory failure (5.9%). Conclusion: This study represents the most recent nationwide data on causes for hospitalization and mortality in patients with heart failure across the United States, with the most common cause of both being heart failure itself followed by sepsis and NSTEMI. A better understanding of why patients are hospitalized may lead to changes in practice to prevent admissions as well as in-hospital management to ultimately prevent death.
Abstract 243: Drone-delivery Of Automated External Defibrillators Before Ambulance Arrival In Suspected Out-of-hospital Cardiac Arrest
Authors: Sofia Schierbeck, Anette Nord, Leif Svensson, Andreas Claesson
Journal: Circulation (2022)

Introduction: Early defibrillation is essential for increasing survival in out-of-hospital-cardiac-arrest (OHCA). Previous studies on AED-delivery using drones have shown that the method is feasible and has potential to shorten time to defibrillation. However, it is still unclear if drones can deliver AEDs before ambulance arrival with clinically relevant time benefits in real-life suspected OHCA. Our aim was to investigate if drones, used as a complement to standard care, can deliver AEDs before ambulance arrival in real-life suspected OHCA in Sweden. Method: Five AED-equipped drones were placed in separate sectors within two controlled airspaces around Gothenburg, Sweden. In cases of suspected OHCA during a study period of 11 months, a drone was dispatched by the dispatch center. A drone operator deployed and remotely surveilled the autonomously responding drone (beyond visual line of sight), which on arrival winched down an AED. The dispatchers then instructed the callers to retrieve the AED. The drone range one-way was 6 kilometers and the drone had a velocity of approximately 60 km/h. Alerts to no-fly zones and alerts in rain and wind &gt; 8 m/s were excluded. Time to AED delivery was compared to standard of care ambulance delay in each case. Results: A total of 223 suspected OHCA were observed in the study areas. In 72 (32%) cases a drone took off, out of these an AED was delivered in 58 (81%) cases. In 56 cases, arrival times for both drone and ambulance were available. The AED-delivery occurred prior to ambulance arrival in 36 of these cases (64%) with a median time benefit of 3 min and 14 sec. Totally 6 patients (11%) had an AED attached, amongst them two were defibrillated and one patient survived 30 days. The main reasons for non-flights were weather conditions (16%), cancelled by dispatch center (17%) and service offline (13%). Conclusion: The use of AED-equipped drones has potential to enable AED delivery prior to ambulance arrival in many cases of suspected OHCA and the time benefit seen in this study indicates potential to facilitate defibrillation before ambulance arrival. However, more improvements and studies are needed to further increase time benefits and the proportion of cases where an AED is attached and used before ambulance arrival.
Abstract 15808: Frequency and Impact of Repeat Transthoracic Echocardiography in Inpatients Transferred for Transcatheter Aortic Valve Replacement
Authors: Matthew Nardi, Rory B Weiner
Journal: Circulation (2022)

Introduction: Appropriate ordering of cardiac imaging is an important factor in optimizing cardiac testing and resource utilization. Echocardiography is frequently repeated when patients are transferred from one hospital facility to another. This single-center retrospective study aimed at assessing the frequency of repeat transthoracic echocardiography (TTE) and its clinical implications prior to non-elective transcatheter aortic valve replacement (TAVR) in patients transferred from referring hospitals. Methods: During a 2-year period there were 62 patients (32 male; mean age 79.8 + 9.4 yrs) transferred from referring hospitals to an academic referral hospital for non-elective TAVR.. All patients had a TTE performed prior to transfer. Patients were grouped based on whether the accepting hospital performed a repeat TTE prior to the TAVR procedure during the index admission. Values for left ventricular ejection fraction (LVEF), calculated aortic valve area, mean aortic valve (AV) gradient, and peak aortic valve gradient were compared between the outside and accepting hospital TTE reports. Results: Of the 62 hospital transfers, 34 (54.8%) had a repeat TTE performed by the accepting hospital. Average time waiting for a repeat TTE was 2.3 + 1.5 days. Measurements of LVEF (48.8% + 14.5 vs 51.7 + 16.2 [P=0.44]), aortic valve area (0.7 + 0.2 vs 0.7 + 0.2 [P=0.53]), mean AV gradient (46.2 + 18.7 vs 45.1 + 14.8 [P=0.78]) and peak AV gradient (76.2 + 31.3 vs 74.9 + 23.3 [P=0.86]) among patients who had a repeat TTE performed by the accepting hospital were not statistically different than values obtained at the referring hospitals. Conclusions: Patients transferred to an academic referral center for TAVR had repeat TTE performed more than half of the time. Our data indicate that key echocardiographic parameters (LVEF, aortic valve area, and AV gradients) were not different between the TTEs at the referring and accepting hospitals. It is possible that improved digital efforts at image sharing across hospitals may obviate the need for repeat cardiac imaging and improve efficiency of care. Such efforts may impact hospital length of stay and cost, and warrants further study on a larger scale.
Abstract 15833: Impact of Sex on Outcomes Following Aerobic Exercise Training in Patients With Symptomatic Atrial Fibrillation
Authors: Adrian D Elliott, Christian Verdicchio, Rajiv Mahajan, Melissa E Middeldorp, Celine Gallagher, Dennis H Lau, Prashanthan Sanders
Journal: Circulation (2022)

Introduction: Aerobic exercise prescription may promote maintenance of sinus rhythm in patients with atrial fibrillation (AF). Very little data exists on whether this may be modified by patient sex. Hypothesis: Male and female patients with AF would benefit from exercise prescription. Methods: This study was a prospective, randomized, controlled trial of patients with symptomatic paroxysmal or persistent AF, referred for consideration of AF ablation. Randomization was 1:1 to either aerobic exercise intervention or usual medical care for a period of 6 months with a further 6 months follow-up. The exercise intervention was delivered in a hybrid format of weekly supervised exercise sessions coupled with prescribed home exercise, up to a total of 210 minutes per week. The intervention was led by a clinical exercise physiologist. Management of arrhythmia was at the discretion of a cardiologist blinded to patient randomization. The primary endpoint reported here is recurrent AF without rhythm control strategies. Results: Of the 120 patients enrolled in the study (Aged 65±10, BMI 30±6, 38% Persistent AF), 51 were female (42.5%). Female patients were less likely to have persistent AF at baseline (19.6%) compared to males (47.8%), had comparable BMI (30.8 v 30.2 kg/m 2 ), were older (68±7 v 63±11 years) and had lower baseline peak oxygen uptake (16±4 v 23±5mL/kg/min, p&lt;0.001). After 12-mnths of follow-up, both male (HR 0.52, 95% CI: 0.29-0.91, p=0.02) and female patients (HR 0.47, 95% CI: 0.23-0.95) in the exercise group had reduced recurrence of AF without anti-arrhythmic medication or AF ablation. Conclusions: Despite baseline differences in risk factor profile, aerobic exercise training is equally effective in males and females for the reduction of recurrent arrhythmia amongst patients with symptomatic atrial fibrillation. Exercise-based intervention should be recommended to patients of both sex, to promote the maintenance of sinus rhythm.